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Are we ready for an emergency

Adamson, Kaashiefah (2012-12)

Thesis (MMed)--Stellenbosch University, 2012.

Thesis

Introduction
Trauma and emergencies contribute to the quadruple burden of disease in South Africa and being prepared for an emergency requires rapid access to emergency equipment, drugs and emergency trolleys to optimally manage an emergency. This is the first descriptive study looking specifically at essential emergency equipment, drugs and the emergency trolley required for the provision of optimal emergency care at Community Health Centres (CHCs) in the Western Cape Metropole.
Aims and Objectives
The aim of the study was to evaluate whether eight 24 hour emergency units at CHCs in the Western Cape Metropole had the appropriate and essential emergency equipment, drugs and emergency trolleys necessary for the delivery of optimal emergency care, using the Emergency Medicine Society of South Africa (EMSSA) guidelines as the audit tool.
Objectives included:
1. To assess availability of essential emergency equipment
2. To assess availability of essential emergency drugs
3. To assess the functionality of existing emergency trolleys
Methodology
EMSSA guidelines were used as the evaluation audit tool to perform a survey of emergency equipment, drugs and emergency trolleys at eight 24 hour CHCs in the Western Cape Metro pole. Data collection for the study was conducted at the eight 24 hour CHCs over a 3 month period during the months of June 2012 to August 2012. The data was analyzed using the Statistical Package for Health Sciences (Statistica, version 10 of 2012) and Microsoft Excel.
Results
A total of 81 emergency equipment items, 43 emergency drug items (37 emergency drugs, 6 intravenous fluids) and 78 emergency trolley items were required to be in each emergency unit. An average of 62% of all recommended emergency equipment items, 80% of all emergency drugs and 52.4% of all emergency trolley items were found to be present in this survey. Essential emergency paediatric equipment including bag ventilation devices, Magill’s forceps, masks, intraosseous needles and appropriate blood pressure cuffs were found to be absent at 2 CHCs. All CHCs had access to a defibrillator and ECG machine but these were found to be dysfunctional at 2 CHCs due to expired batteries and no tracing paper being available. Expired first line emergency drugs (adrenaline and atropine) were found at certain CHCs. The recording of emergency trolley checklists and stocking of essential emergency items were found to be incongruent, inconsistent and not up to the recommended standard.
Conclusion
Essential emergency equipment and drugs and the functionality of emergency trolleys were found to be generally inadequate. Considerable deficiencies of essential emergency items were found, particularly paediatric equipment and drugs and this may negatively impact on resuscitative efforts and outcome in both paediatric and adult emergency care at CHCs in the Western Cape Metropole.